Transcript Seniors as Patient Safety Self

Seniors as Patient Safety
Self-Advocates in
Primary Care
Saundra L. Regan, PhD
University of Cincinnati
Department of Family & Community Medicine
Cincinnati, Ohio, U.S.
Objectives of Today’s
Presentation
1. What are Patient-Centered & Family-Centered Health
Care?
2. What are the issues in Patient-Centered & FamilyCentered Care and why is it so important in Geriatrics?
3. The Seniors’ Empowerment and Advocacy in Patient
Safety (SEAPs) tool.
4. What is the Patient-Centered Medical Home (PCMH) in
Primary Care?
5. Next Steps
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Brief Description of PatientCentered & Family-Centered
Health Care
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Health Care Is
Physician-Centered
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Health Care is
Facility-Centered
Hospital
Clinic
Nursing Home
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President Obama:
“It use to be that most of us had a family doctor. You
would consult with that family doctor. They knew your
history. They knew your children. They helped deliver
babies.”
Today:
“Oftentimes, people don’t have a primary care physician
that they’re comfortable with, so they don’t get regular
checkups. They don’t get regular consultations.
Preventable diseases end up being missed.”
6/8/2010. Town Hall Meeting, Wheaton, Maryland President Obama
Calls for Better Payment System for Primary Care Physicians
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Patient-Centered Health Care*
• The healing relationship between physicians and
patients and patients' families
• Grounded in strong communication and trust
• Highlighted by clinicians and patients engaging in
a two-way dialogue
• Sharing information
• Exploring patients' values and preferences
• Helping patients and families make clinical
decisions
*Institute of Medicine's Crossing the Quality Chasm 2001
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Patient-Centered Health Care*
• “Shared Information” — a physician tailors
information to an individual patient's concerns,
beliefs, and expectations, while also considering
his or her level of health literacy
• "Shared deliberations”—engage the patient in
discussions and decision-making to help arrive at
a….
• “Shared mind"—that is, consensus on an
approach to care that goes beyond informed
consent.
*R. M. Epstein, K. Fiscella, C. S. Lesser, and K. C. Stange, "Why the Nation
Needs a Policy Push on Patient-Centered Health Care," Health Affairs, Aug. 2010 (29)8:1489–95.
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Family-Centered Health Care*
• Health care providers listen to, respect and
honor patient and family perspectives and
choices
• Health care providers communicate and share
complete and unbiased information with
patients, families, and other providers
• Patients and families are encouraged to
participate and collaborate with their
providers
*http://www.familycenteredcare.org/
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Issues in Patient-Centered &
Family-Centered Care and the
Importance in Geriatrics
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The Aging Population
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Canadian Demographics
Total Population (2010 est.)
• 34,019,000 (2010 est.)
Age structure:
• 0-14 years: 15.9%
• 15-64 years: 68.6%
• 65 years and over: 15.5%
Median age:
• total: 40.7 years
• male: 39.6 years
• female: 41.8 years
Life Expectancy:
• total population: 81.29 yrs.
• male: 78.72 yrs.
• female: 84 yrs.
Fertility rate:
1.5 children per woman
https://www.cia.gov/library/publications/the-world-factbook/geos/ca.html
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Chronic Diseases
• Changing epidemiology of disease burden
from infectious disease to chronic disease
related to:
– Aging population
– Lifestyle factors
•
•
•
•
Excessive calorie intake
Diminished physical activity
Smoking
Alcohol
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Leading Causes of Death
Ages 65 and Over*
1. Cancer
2. Heart Disease
3. Chronic Lower Respiratory Disease
(Chronic Bronchitis, Emphysema, COPD,
Asthma)
4. Stroke
5. Diabetes
6. Alzheimer’s (75+)
*http://www.statcan.gc.ca/
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Who Cares for Older Adults?
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Why Teach Seniors to be Patient
Safety Advocates?
• Aging Population
• More Chronic Disease
• Older adults cared for in the community
by their family and friends
• Healthcare being provided by a family
physician, general practitioner or
healthcare team.
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Senior Empowerment and
Advocacy in Patient Safety
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Senior Empowerment
• The best way to empower older adults is to
teach them to be advocates for their own
safety.
• If you don’t do it, who will?
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Developing the Tool
• At the time we started our study we couldn’t find
an instrument to assess patients’ beliefs about
participating in safety activities in a primary care
office setting.
• We wrote a grant and received funding from the
National Patient Safety Foundation to develop the
Seniors’ Empowerment and Advocacy in Patient
Safety (SEAPs) tool.
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Seniors’ Empowerment and
Advocacy in Patient Safety
Four Areas of Focus
• Outcome efficacy: the belief that the actions
will be a benefit to one’s health,
• Attitudes: concerns about barriers to
participating in the actions,
• Self efficacy: confidence in one’s ability to
effectively take action,
• Behaviors: performance of patient safety
actions
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Seniors’ Empowerment and
Advocacy in Patient Safety
• Developed a tool that could be used to
evaluate a program that taught older adults
to be advocates in their own patient safety
in a primary care office setting
• The tool was tested and worked well with
older persons regardless of gender, race,
income or education level.
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Why Teach Seniors to be Patient
Safety Advocates?
• Older adults are at higher risk for errors in
health care:
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–
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Use the health care system more often
Often have multiple health problems
Often see several doctors for care
Often take multiple medications
Our culture teaches us not to question our
doctors and until recently we’ve not been
taught to take an active role in our own
healthcare
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Seniors’ Empowerment and
Advocacy in Patient Safety
Using the tool in the community to evaluate a
community intervention with older adults
about patient safety.
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Seniors’ Empowerment and
Advocacy in Patient Safety
Part I: Group Educational Event
• Introduction and description of medical errors in
physicians’ offices
• Stories of medical errors that occurred to real
patients (misdiagnosis, mishandled records)
• Group discussion of participants experiences with
medical error and preventable problems
• Description and training in patient safety practices
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Patient Safety Practices
PREPARING FOR THE VISIT
• Write down all your medical problems and questions
• Write down all the medications
• Learn more about your medical problem before going to the doctor
DEALING WITH THE OFFICE STAFF
• Try to make your appointment the first or last of the day
• Speak up to the office staff, and let them know what you want
TALKING WITH THE DOCTOR
• Give a thorough medical history
• Ask questions about what your doctor tells you
• Ask questions about your medications
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Patient Safety Practices
MAKING DECISIONS ABOUT A DOCTOR
•
•
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Choose your doctor wisely by checking him/her out beforehand
Get another opinion if you are not satisfied with your care
Change to another doctor or office if you continue to be dissatisfied with your
care
AFTER THE DOCTOR’S VISIT
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•
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Check the medicine at the pharmacy to make sure it is the right one
Learn all you can about your health problems
Call or visit the doctor if you don’t get lab results in a reasonable amount of
time
GENERAL IDEAS
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Trust your gut feelings or instincts about whether something is working or not
Get a friend or family member to come with you to the visit
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Seniors’ Empowerment and
Advocacy in Patient Safety
Individual Training Session
• Introduction and description of PACE program (Present, Ask,
Check and Express) (Cegela et al, 2000)
• Detailed instruction in how to present detailed information to the
doctor
• Training about communicating about medications and keeping a
medication record form
• Training about communicating about tests and their results and
keeping a test results record
• Participant selection of patient safety practices and PACE skills to
adopt
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The PACE Guide Sheet
PRESENT Detailed Information
• Describe your problems and concerns
ASK Questions
• Ask doctor to repeat or clarify information that is unclear
about diagnoses, tests, medications, treatments
CHECK Your Understanding
• Repeat aloud what the doctor just said
• Summarize your understanding of what the doctor said
EXPRESS Concerns
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The PACE Guide Sheet
Don't Forget To:
• Bring all your medications, or make a list of them and how
they are taken
• Ask for a copy of test results or procedure reports
Practice:
• Participant selected a patient safety practice and a PACE
skill to adopt and we role-played that skill
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Results-Participant Comments
• PACE helped organize their thoughts and questions before
they went into the doctor’s office
• Have the 2 or 3 things that they really needed to talk about
because they get in the doctor’s office and forget what
they wanted to ask
• If I can go in with a summary of what is wrong such as, “I
have a pain in my upper back that started 2 weeks ago
after I worked putting in some flower gardens. It hurts
when I have been standing or sitting too long so I have to
get up a walk every so many minutes. Tylenol has really
not been helping so I tried Advil and that helped a little
more but the pain still comes back”
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Results-Participant Comments
• Being able to tell the doctor what happened, when, how it
feels and what you’ve tried to make it better is really
helpful to the doctor
• Supplements: Many people expressed they don’t think of
their supplements and vitamins as medication. Many
didn’t realize their prescription medication and the
supplements they might be taking could interact with each
other
• Over-the-counter: Many didn’t realize the importance of
listing all medications, supplements, vitamins, other over
the counter medications, eye drops and so forth.
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Results-Participant Comments
• Specialists: Also many made the assumption that
if one doctor put them on something another
doctor would automatically know that and so it
was important to always bring a list of your most
recent medications, supplements, etc.
• Testing: almost everyone expressed the same
thought, “they never think to call their doctor if
they haven’t heard about test or procedure
results.” Almost all believed that no news is good
news.
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A Cancer Test Result
• “No News is Good News”
• Or
• “No News is No News”
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Seniors’ Empowerment and
Advocacy in Patient Safety
• We developed safety self advocacy
recommendations for patients that:
– Covered important areas of errors and
safety in primary care
– Are realistic and feasible for many patients
to undertake
– Can be taught to patients in a community
setting
BUT………………..
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Results-Participant Comments
Their Parting Shot……..
• If we are going to activate and empower patients
to be their own patient safety advocates…..
• We need doctors and other healthcare providers
who understand and incorporate this into their
clinical practices
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Next Steps We Enter………
The Patient-Centered Medical
Home (PCMH) in Primary Care
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Patient Centered Medical Home
• The American Academy of Pediatrics introduced
the term “medical home” in the 1960’s
• The Institute of Medicine began to use the term in
2001 as one of six aims for high quality in patientcentered care
• The American Academy of Family Physicians
adopted it in 2004
• The College of Family Physicians of Canada (CFPC)
recommended it in 2009
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Patient Centered Medical Home
Core Components
• Personal physician with whom you develop an ongoing
relationship
• Physician Directed Medical Practice of a Health Care Team
• Whole Person Orientation
• Care is Coordinated and Integrated
• Quality and Safety
• Enhanced Access-Open access
• Payment Reform
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THE TEAM
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THANK YOU!
QUESTIONS? COMMENTS?
[email protected]